GOLFER'S ELBOW, SIMPLE CURE:
Typically the cause of medial (inner) elbow pain is grabbing more with the hand/wrist than extending the hand/wrist.
Thus the wrist flexors and finger flexors become much stronger than the wrist extensors and finger extensors.
If you’re wondering
In other words, if you’re looking at your palm you’re looking at the side of the flexors; if you’re looking at the back of your hand you’re looking at the extensors.
Lengthen the flexors, strengthen the extensors, and the golfer’s elbow pain typically clears up pretty easily.
So if that area tends to hurt most, it may be as a result of
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1. Don’t Do Biceps Curls With A Straight Bar
As I mentioned a couple of weeks ago, if you asked me to make a list of the exercises most likely to eventually cause medial epicondylitis/golfer’s elbow (which again is pain on the inner side of the elbow),
In what will become a very noticeable trend throughout this article, the straight bar just tends to complicatefor a lot of exercises for a lot of people. And this is MUCH more pronounced when you’re grabbing that straight bar with an underhand grip.
You know, just like you’d grab it if you were doing biceps curls.
It’s just an unnatural position for your wrists and forearms to be in, and most people find that they feel just slightly uncomfortable whenever they do it.
That slight discomfort IS the problem.
See, the thing about these two elbow injuries is that they’re less about what your elbows are doing, and more about what your fingers, hands, wrists and forearms are doing along with the tendons that run through them and attach at your elbows.
Which is why that slight misalignment of your wrists caused by the unnatural way the straight bar forces you to grip it will — under heavy repeated loading — be very capable of killing your elbows.
For this reason, I’d highly recommend avoiding straight bar curls. Completely.
Instead, the EZ curl bar will be a much better, safer and wrist/elbow friendly option (full details: EZ Curl Bar vs Straight Bar). And dumbbell curls (which will allow you to put each dumbbell into whatever position your body naturally prefers individually of the other) will be the best and safest option of all.
One other curling tip specifically for those currently dealing with medial epicondylitis:
2. Avoid Chin-Ups and Underhand Grip Lat Pull-Downs
Take everything I just said about straight bar curls and replace the word “curls” with “chin-ups” or “underhand grip lat pull-downs.”
It’s virtually the exact same scenario (a straight bar being held with an underhand grip) causing the same issues (unnatural wrist/forearm position) with the exact same potential consequences (medial epicondylitis).
The only difference is that you’ll be lifting much more weight on these exercises than you would be with curls, and often doing so with higher intensity and lower rep ranges… all of which only increases the potential for elbow problems.
Instead, I’d highly recommend doing pull-ups (overhand grip), neutral grip pull-ups (palms facing each other) or using rings which will allow you to rotate your wrists naturally as you perform each rep.
The same goes for lat pull-downs. Stick with an overhand or neutral grip instead of underhand.
Or, if you absolutely must use an underhand grip on these exercises for whatever reason, at least use some type of angled bar (sort of like an EZ curl bar) so that your wrists aren’t completely supinated.
3. Watch Out For Underhand Grip Rows, Too
Pretty much the same as above. While doing rows with an underhand grip on a straight bar doesn’t seem to be AS problematic for your elbows as vertical pulling movements with an underhand grip are, it can still definitely cause problems.
So, just like before, I’d recommend doing your rows with either an overhand or neutral grip instead. Or, if you’re going to be using an underhand grip, at least go with some kind of angled bar that is somewhere between underhand and neutral rather than completely underhand.
4. Avoid Skull Crushers (Or At Least Do Them Smarter)
Skull crushers are a popular triceps exercise that involves lying on a bench (typically flat, sometimes decline, sometimes incline) with the weight (typically a barbell) held in your hands directly over you similar to the top position of a bench press. It’s then lowered down right over your face/head (hence the name “skull crusher”) by bending at the elbow.
And skull crushers are popular for a reason… they can be a fantastic triceps exercise. I’ve personally always liked them.
But the bad news is that they have one major downside. They tend to be one of the most common causes of elbow pain on the lateral (outer) side of the elbows. Think of them as the triceps equivalent of the straight barbell biceps curl.
The easiest way to avoid the problems this exercise commonly causes is to simply avoid it completely. For some, this will be the best option. However, it’s not the only option.
You see, there are smarter ways to do skull crushers that will instantly take a significant amount of stress off of the elbows compared to how most people usually do them.
The first step is to NEVER use a straight bar for these. Ever. Not even once. If you must use a barbell, always go with the EZ curl bar. Just like with curls, it allows your wrists to be in a much more natural and comfortable position that will make this exercise a lot more elbow-friendly.
But the most elbow-friendly version of all doesn’t involve any type of barbell. Dumbbell skull crushers (with your palms facing each other) are the safest way to do them.
The second step is to adjust how you lower the bar/dumbbells. The further down on your face you lower the weight to, the more stress it will place on your elbows. So lowering to your chin is a terrible idea. Lowering to your nose is a terrible idea. Lowering to your forehead is a little better, but still not ideal in terms of elbow health.
Instead, the ideal way to lower the weight is by letting your elbows drift back slightly (rather than locking them in place pointing straight up and never letting them move at all) and lowering the weight towards the top of your head or (better yet) just a bit over the top of it.
And also note that some people will have similar problems with overhead triceps exercises as well.
5. Keep An Eye On Pull-Ups
Earlier I mentioned chin-ups being a common cause of elbow injuries on the medial side, and listed pull-ups with an overhand or neutral grip (or rings) as a safer replacement. And it definitely is. By a ton.
Here’s the thing, though.
Done long enough and heavy enough, the potential for elbow issues is still there to some extent. Especially for those of us that are either using a lot of volume and/or frequency, or are just going fairly heavy with them (i.e. doing them with additional weight).
For this reason, I have a few recommendations:
6. Keep Biceps And Triceps Exercises Lighter And Higher In Reps
You know how I just mentioned that certain exercises are better suited for being done heavy in lower rep ranges? ...isolation exercises are not exercises I’d put in that group.
This would apply not only to biceps and triceps movements, but to virtually all isolation exercises for all body parts. Calf raises are the only exception that comes to mind.
But stuff like various biceps curls and triceps extensions on the other hand? . The same goes for stuff like lateral raises, leg extensions and dumbbell flyes. These are not your 4-8 rep range movements. These are your 8-15 rep range movements. Maybe even 10-15.
That’s not to say you couldn’t do exercises like these for 4-8 reps. You certainly can. I just wouldn’t consider it an ideal use of these movements or that good of an idea in general.
There’s a few reasons for this.
One is just the single-joint “isolated” nature of these exercises, most of which involve your joints, tendons and muscles being put under tension in compromising positions where TOO much tension can so easily be problematic from a safety standpoint.
Not to mention, from a technique standpoint as well. I mean, just try to go heavy enough on these types of exercises to warrant something like 5 reps and let me know how well your proper form remains intact.
Or better yet, look around your gym. You’re bound to see people trying and failing to do this on a daily basis.
Now specifically regarding elbow injuries… think of it like this. When you combine the compromising position isolation exercises put your muscles, joints and tendons in with exercises like barbell curls and skull crushers which already come with their own increased risk of injury, you end up with one terribly unsafe scenario.
That’s why I’d recommend using your biceps and triceps isolation exercises more as “fatigue” movements rather than “progressive tension” movements.
This is when you want to focus on feeling the muscle working, fatiguing them, squeezing hard, lowering slower and getting a good “pump” more so than just getting strong as possible and constantly upping the weight.
Save that for the bigger, more important stuff.
I personally don’t go below 10 reps on any type of curl or triceps extension anymore and should have started doing this years ago. The 10-15 rep range is, in my opinion, the sweet spot for arm training. Not just for injury prevention, but for muscle growth as well.
Turns out the biceps and triceps respond quite well to this sort of training, especially when combined with the heavier lower rep work they indirectly get plenty of during all of your compound pressing and pulling exercises.
This combination = better looking arms and healthier elbows.
7. Drop The Excessive Amount Of Biceps/Triceps Work
And speaking of better looking arms… isn’t that something we all want? Probably. And isn’t training biceps and triceps something most people find to be pretty fun? Usually.
This combination is probably why it’s so common to see people doing a TON of direct arm work.
Unfortunately, most of that direct arm work is just excessive stress being placed on your elbows that isn’t needed or beneficial to your goal of building pretty looking arms. It’s actually much more likely to be counterproductive to that goal than it is to be useful for it.
The truth is, your biceps and triceps get plenty of indirect volume during all of the compound pressing and pulling exercises that make up the majority of your upper body training.
So much so that after that, very little direct biceps and triceps work will be needed to maximize growth. In fact, some people do just fine with no direct arm training whatsoever (no doubting that) and consider compound exercises to be all anyone needs (though I’d completely disagree with that).
But there is definitely a limit to how much is needed beyond the volume that comes from compound exercises. All biceps/triceps work beyond that amount is just extra stress on your elbows with nothing positive to show for it.
So assuming your overall training program is designed intelligently, the majority of the people reading this will need no more than 4-6 total sets of direct biceps training per week, and 4-6 total sets of direct triceps training per week.
8. Avoid The “Dead Hang” Position On Pull-Ups/Pull-Downs
I know, it doesn’t count as a complete pull-up rep unless your arms are fully extended and you’re starting from a complete dead hang. I always did my pull-ups like that, too.
And with lat pull-downs, if you don’t let that bar go all the way back up until your elbows are fully locked out, you’re not doing full reps either. I always did my lat pull-downs like that, too.
While doing these exercises this way will provide a slightly better stretch in your lats, and it’s great advice for the general population who tends to do pathetic looking half/quarter reps on every exercise including these, this “dead hang” position is the point in each rep where the most stress is being placed on your elbows.
Just like how the most elbow-unfriendly position of a supinated (underhand) barbell curl is at the very bottom when your elbows are fully extended. It’s basically the point when the tendons are being “pulled on” the hardest.
So what does this mean exactly?
Well, as long as you don’t fit into that second category (pathetic half reps), you may benefit from stopping ever so slightly before reaching that dead hang/completely locked out position on pull-ups and lat pull-downs, especially if you’re currently dealing with inner elbow pain or have had similar issues in the past.
9. Avoid Thick Bars and Fat Gripz For Back/Biceps Exercises
Good way of improving grip/forearm strength and size?
Good way of placing a whole lot of additional stress on your grip, forearms and elbows?
So if your gym has different barbells that are thicker than others, or different bars for seated cable rows and lat pull-downs that are thicker than others, or various machine rows that have handles that are thicker than others, I’d recommend avoiding those in favor of the thinnest bars/handles you have available.
I’d especially recommend this one to anyone who is currently dealing with medial epicondylitis or has ever dealt with it in the past. There’s a bunch of equipment in my gym that I purposely avoid for this very reason.
10. Stop The Excessive Pressing
There are a few good reasons to stop the infinite amount of pressing exercises the average gym goer does on a regular basis.
You know how the typical “chest day” goes: 3-5 sets of flat bench press, incline bench press, decline bench press, various dumbbell presses, machine presses and “fly” movements… plus 3 triceps exercises (dips, skull crushers, pushdowns). And don’t forget the 2-4 different types of shoulder presses that same person will be doing on “shoulder day.”
But besides just being a TERRIBLE way to train, and besides being a pretty near guaranteed way to destroy your shoulders… it also happens to be one of the most common reasons people eventually experience pain on the lateral/outer side of their elbows.
11. Training Breaks Are A REQUIREMENT
Even if your training is perfectly designed, and you’re using perfect form on everything, and you’re avoiding all of the exercises that tend to be most problematic, and you’re following all of the advice in this article… there is still one thing that can lead to injuries.
And that’s just the simple fact that your body can only take so much hard training.
I mean, you can’t expect to work your head off lifting progressively heavier things 3-5 times per week, 52 weeks a year, year after year, without some part of your body (muscles, joints, tendons) giving in somewhere.
You just can’t constantly go at 100% without problems eventually developing.
Which is why in order to prevent injuries, prevent minor injuries from becoming major, stay healthy, stay motivated and actually make progress and get results, you need to occasionally back off a bit and let EVERYTHING get a chance to rest, recover and heal.
It doesn’t even need to be actual time off from training. It certainly can be, but there are other options.
I’m of course talking about deloading, which is basically where you take an easy week or two where you continue training, but at a reduced level of intensity (perhaps lifting 80% of your usual weights) or volume (perhaps doing half as many sets as you normally do), or some combination of the two.
And please keep in mind that this isn’t something you should take as a suggestion. It’s not. This is a requirement.
12. Make Sure Your Hands, Wrists, Forearms And Elbows Stay In Line
Like I keep saying, these elbow injuries are less about what the actual elbow joint itself is doing and
For this reason, you want to make sure everything stays in line right behind the other in relation to the line of resistance.
Hand… wrist… forearm… elbow.
Let me show you a few examples of what I’m talking about using screenshots from random YouTube videos with the seated cable row being our example exercise…
With the help of my beautifully drawn red line (I have 10+ years of experience with Photoshop, can you tell?), I’d like you to compare the alignment of this dude’s hand, wrist, forearm and elbow to the alignment of the hand/wrist/forearm/elbow of the guy below…
Can you spot the difference? The second guy has it right.
Now why does what you see in the first picture happen? Sometimes it’s just bad form… a person using a line of pull that doesn’t suit the grip or equipment being used. For example, just compare the angle of the cable itself in both of these pictures. The first guy’s cable is on an angle (he’s pulling to a point too high on his body), while the second guy’s cable is perfectly straight.
But sometimes this sort of thing happens just as a result of using poor equipment. For example…
This girl’s hand, wrist, elbow and forearm are similarly out of position like the first guy (her elbow is below her wrist when they should be even), but in this case it’s not her fault. She’s just using a very poorly designed seated cable row machine, at least for the grip she’s trying to use.
My old gym had a few just like this. They hurt
You can see the cable in this case is straight. She’s not pulling it too high like the first guy. The machine she’s using is just designed in a way where the line of pull originates too high, thus forcing her to pull to about chest level when she’s pulling it straight.
The problem of course is that for type of grip being used (narrow neutral grip), she needs to be pulling to her stomach like the second guy from before… not her chest. With this specific machine, she’d need to use a wider overhand grip on a straight bar for everything to line up correctly.
And this misalignment of the hands, wrists, forearms and elbows is definitely not limited to seated cable rows.
That includes every kind of row, pull-up and lat pull-down.
It also includes every type of pressing exercise. For example, imagine a barbell bench press where, at the bottom position, the person’s wrists are not in line over their elbows (usually happens because the bar path is too far forward or too far back, or because the grip is too wide or too narrow).
It’s a completely different type of movement than something like a seated cable row, but it’s the exact problem.
If you allow this misalignment to take place long enough, elbow injuries are likely to occur. Pay attention.
13. Make Sure Your Wrists Remain Straight
In addition to wanting everything to line up correctly, you also want to make sure your wrists are straight in general and not bent forwards or backwards.
Here’s an example of someone doing a bent over barbell row…
Check out what’s happening inside my pretty red circle. Notice how that guy’s wrist is bent and not straight? Go heavy enough long enough and that’s a flexor tendon injury waiting to happen. (And no, Johnny Tanktop never pointed this out or corrected it in the video.)
And again, this sort of thing can happen on all kinds of exercises, and again it can happen due to bad from or bad equipment. Or both.
So be sure to pay close attention to the position of your wrists during everything from pull-ups/pull-downs and rows, to various types of curls (pay extra attention here… don’t curl with bent wrists) and triceps extensions, to all kinds of chest and shoulder pressing exercises.
14. Don’t “Crimp.”
One thing I learned early on when dealing with my own elbow issues is that medial and lateral epicondylitis are both VERY common rock climbing injuries. So common that golfer’s elbow is sometimes called “climber’s elbow.”
In fact, I’d rank rock climbers at the top of my list of people who truly understand these injuries.
Coincidentally, with medial epicondylitis specifically, it’s often pull-ups/chin-ups that cause pain first (and often cause the most pain), and it just happens to be the closest exercise there is to a rock climbing type of movement.
And in talking with various rock climbers and the one doctor I came across who actually knew a ton about these injuries (he just happened to deal almost exclusively with rock climbers), one thing I kept seeing recommended is to avoid “crimping.”
As someone who knows nothing about rock climbing, I had no idea what that meant. But once I figured it out, it made sense and applied quite well to weight lifting too.
Crimping in the rock climbing world refers to a type of grip where you’re basically grabbing the rock only with your finger tips, thus putting all of your weight on them.
In the weight lifting world, imagine grabbing a pull-up bar, or a lat pull-down bar, or a barbell/dumbbell/machine for some type of row, but holding it more in your fingers than in your palm. Or maybe you started out with the weight more in your palm but as the set progressed it slipped into your fingers. And maybe by the last few reps, you’re basically just hanging on by your finger tips.
That’s what I’d consider to be the weight lifting equivalent of crimping. Don’t do that.
Grab the barbell, dumbbells, handles or whatever other equipment you’re using so that it sits in your palm and lower part of your fingers. And if you’re still having grip issues where the weight is slipping into your finger tips… it’s time for straps.
Speaking of which…
15. Use Straps!
For the 1000th time, everything your hands, fingers, wrists and forearms do affects the tendons that connect at your elbows. Put too much stress on those tendons and elbow pain/injuries will likely follow.
One way to minimize that stress is by minimizing the amount of work your “grip” has to do. You know, like gripping a heavy barbell, dumbbell or machine handle during all forms of rows, deadlifts and shrugs, or gripping the bar during pull-ups and lat pull-downs.
And one of the quickest and simplest ways of doing that is by using straps. In fact, elbow injury prevention is just one reason why I recommend using them. More about that here: Weight Lifting Straps
How often you use them is up to you. Some might only save them for their heaviest sets when their grip is a limiting factor. That’s fine. Some might prefer using them a bit more often. Hey, that’s fine too.
My only advice would be for people currently dealing with an elbow injury or people who have dealt with one before and are looking to prevent it from coming back. In those cases, I’d suggest using straps a bit more often. The less work your grip has to do during these exercises, the healthier your elbows will be.
Also consider using Versa Gripps Pro in place of traditional straps. I do.
16. Avoid heavy, Maxed-out stiff arm pullovers!
Doing really heavy or maxing out on this exercise greatly taxes the flexors, this inner elbow problems.
17 Pay Attention To Cardio And Leg Training, Too
I know what you’re thinking. What does cardio and leg training have to do with elbow injuries? I mean, that’s an upper body thing, right? Kinda.
With cardio, jogging on a treadmill or sitting on a bike won’t be a problem. But a rowing machine? That has the potential to be more stressful on your elbows than a typical upper body weight training session would. It’s like doing a continuous 30-60 minute set of light straight bar rows.
So if you have a history of golfer’s elbow (or would just prefer to never have a history of it), I’d avoid going anywhere near a rowing machine for cardio.
And what about legs? There’s no elbow extension or flexion during most lower body exercises, so what’s the problem here?
Well, you know those tendons that attach at the elbow? And you know how they’re affected by the stress being placed on your hands/fingers/grip/forearms? Cool. Now let me ask you this.
Do deadlifts place any stress on those parts of your body?
How about various dumbbell lunges, split squats and step-ups?
Basically, any exercise for any body part that involves holding a heavy weight in your hands is putting some degree of stress on those tendons. Now that alone is unlikely to actually cause these elbow injuries. However, in conjunction with the stress being placed on those tendons during your upper body workouts, it serves as another contributing factor in making it happen.
I’m definitely not suggesting that you to avoid these exercises. I certainly don’t. I’m just suggesting that you take it all into account.
For example, when I was dealing with my own elbow problems a few years ago, there was pain just from holding something as light as 135lbs in my hands for deadlifts. So at that time I stopped deadlifting for almost a full year. I also replaced stuff like dumbbell split squats/lunges with barbell variations or single-leg leg presses.
I have long since brought all of that stuff back into my training, but I’m now extra careful about my programming of it and I consciously design things around minimizing the amount of stress being placed on my grip (and the involved tendons) over the course of the week.
18. Do Forearm Soft Tissue Work/Torture
It’s not fun to do and it can hurt. But I’m gonna recommend it anyway.
The ideal way of having soft tissue work done on your forearms is by having someone qualified do it for you on a semi-regular basis. But if that can’t happen, the next best option is to do it yourself. You know, just like foam rolling.
And while the foam roller can be good for many body parts, it hurts for the forearms. You’ll need different tools for this. What kinds of tools, you ask? Anything from a ball to a stick. Let me show you some examples.
Here’s Eric Cressey showing the inner side of his forearm who’s boss using The Stick. I have one of these, and I like it…
And here’s Mike Reinold working on both sides of his forearm using a Thera-Band Roller Massager…
If you want to take it a very expensive step further, there’s this contraption called the Armaid.
Yes, it looks like a cross between a medieval torture device and a sex toy. And sure, there is a bit of an “as-seen-on-TV, only 3 easy payments of $19.95!” sort of vibe to it. And yup, many of the reviews you’ll find for it feel a lot like paid advertisements. And ys, it probably costs 2-3 times as much as it should.
But I saw a handful of rock climbers swearing by the thing (and again, if any type of athlete knows about dealing with these elbow injuries, it’s rock climbers), so I figured I’d give it a try. And I can tell you that it’s actually pretty good. I just need to remember to hide it when people come over.
Here’s a basic demo…
And here’s Kelly Starrett demonstrating a few forearm soft tissue techniques, including using a ball and the Armaid…
19 Beware Heavy cleans
20 Beware Holding heavy Squat weights
There’s not a doubt in my mind that if I would have followed the guidelines laid out in this article just a few years earlier, I would have completely prevented the elbow issues I eventually had. Bold statement, I know… but I stand by it.
There’s also not a doubt in my mind that following these guidelines right now is what’s kept my elbows at 100% ever since (which is currently 2 years and counting).
And last but not least, there’s not a doubt in my mind that following these guidelines will make you as unlikely as possible to ever develop either of these injuries in the first place.
But that brings us to one final question… what if they’ve already happened? What if you’re already experiencing inner or outer elbow pain? What if you’re past the “preventing” stage and are more than ready for the “fixing/healing” stage?
Well, this article is still a fine place to start. But as I mentioned way back at the beginning, fixing the problem when it already exists is a whole other fun and complicated topic of its own. But stay tuned, because I’m definitely going to cover it in the near future.